The Immune System|
rheumatic fever is an autoallergic
disease triggered by infection with specific strains of Streptococcus
pyogenes (group A b-haemolytic streptococci)
which express antigens cross-reactive with those on human connective tissue.
Abnormal humoral and cell-mediated autoimmune response is responsible for the
damage found in different tissues.
It usually affects children or teenagers (5-15 years of age), and there is a definite family variation in susceptibility. This disease can develop only as a sequel to pharyngeal infection by group A b-haemolytic streptococci, but only 3% of those with this type of infection will acquire rheumatic fever. Streptococcal skin infections (e.g., impetigo) do not progress to acute rheumatic fever, although both skin and pharyngeal infections can cause acute glomerulonephritis.
Clinical features: < BACK TO TOP >
Nonspecific manifestations such as fever, lymphadenopathy, generalised aches,
nausea, vomiting, abdominal pain are frequent, but they occur in other
major specific manifestations are:
features (Sydenham’s chorea)
changes (erythema marginatum and subcutaneous nodules).
arthritis of rheumatic fever (sometimes called acute rheumatism, but not to be
confused with rheumatoid arthritis) is an acute painful inflammation of one or
the arthritis moves from joint to joint (so called migratory polyarthralgia).
joints most affected include ankles, knees, elbows, wrists and shoulders, and
there is pain, tenderness and redness, and sometimes an effusion in affected
is commonly, but not invariably, a history
of sore throat 2-4 weeks before the onset of joint symptoms.
Erythema marginatum occurs in 10-20% of children with rheumatic fever, in form of red
macules (blotches) which fade in the centre but remain red at the edges;
the resulting red rings or “margins?may coalesce or overlap.
Subcutaneous nodules are rarely observed and they appear as firm painless
nodules best felt over bones or tendons.
Carditis is the most important manifestation of rheumatic fever; it presents as
palpitations, chest pain (usually due to pericarditis) or breathlessness
is usually a tachycardia and often cardiac enlargement.
common although sometimes difficult to detect; soft diastolic murmur is due to
mild aortic regurgitation, presystolic murmur is due to mitral stenosis
(nodules forming on the mitral valve leaflets).
Cardiac failure may result either from impaired function of ventricular muscle or from
mitral or aortic incompetence caused by valve damage.
Sydenham’s chorea (Saint Vitus’s dance) occurs several months after acute arthritis in
only 3% of all patients, and it is thought to be due to antibodies against
characterised by sudden, jerky, aimless, involuntary movements of face, tongue
and upper extremities, which disappear with sleep, decrease with resting and
increase with emotional stress and attempted voluntary movement.
movements are abrupt with impaired coordination, and the patient may appear
It is more common in girls than in boys, but in both spontaneous recovery is usual (although prolonged 3-12 months), and there are no permanent neurologic sequelae.
Diagnosis: < BACK TO TOP >
of a systemic illness:
leukocytosis, raised ESR and C-reactive protein are usual but non-specific.
of preceding streptococcal infection:
Culture of group A b-haemolytic streptococci from a throat swab is
positive in only a minority by the time rheumatic fever is clinically
detection of streptococci in the throat are also available and can be done in
Antistreptotysin O antibodies (ASO titre),
antideoxyribonuclease B and antihyaluronidase antibodies
are useful evidence of recent streptococcal infection, especially if a rising
titre can be shown.
may show cardiac enlargement or pulmonary congestion.
ECG changes include first degree heart block (prolongation of PR interval),
T wave inversion and reduction in QRS voltages.
Echocardiography is useful for showing cardiac dilation and valve
the diagnosis of acute rheumatic fever is essentially clinical, the Jones criteria have been proposed to simplify this process.
diagnosis of rheumatic fever is likely in the presence of two major
manifestations, or one major and two minor manifestations, plus evidence of
previous streptococcal infection.
carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules.
Minor manifestations: fever, arthralgia, previous rheumatic fever, raised ESR, first degree or second degree AV block.
Management < BACK TO TOP >
is important during the acute phase of rheumatic fever; in patients who have
had carditis, it is traditional to continue to bed-rest for 2-6 weeks after
ESR and temperature have returned to normal.
in large regular doses is effective in providing symptomatic relief of
arthritis, other NSAIDs such as naproxen or ibuprofen may also be used.
should be continued until the ESR has fallen, and then gradually
(prednisolone or prednisone) produce more rapid symptomatic relief than
aspirin, and are preferable in cases with severe arthritis or carditis.
However there is no evidence that the long-term effects are superior.
are administered to eradicate a streptococcal infection.
prophylaxis is introduced by
giving monthly injections of penicillin for the first year, and after that
with oral penicillins until the patient reaches the age of 20 (many authors
recommend only few years of prophylaxis).
failure should be treated as required; valve replacement may be necessary for
severe acute mitral or aortic incompetence.
rheumatic heart disease (usually mitral stenosis) can develop as a consequence of severe acute
rheumatic fever, especially if it recurs later due to ineffective prevention.
Treatment of chorea consists of low doses of benzodiazepines or antipsychotic drugs, but only if there is significant movement disorder.
Prognosis < BACK TO TOP >
Nutrition < BACK TO TOP >
Nutrition that alleviate or prevent Rheumatic fever :-
Herbs < BACK TO TOP >
Herbs that alleviate or prevent Rheumatic fever :-
(source : -)
7 April 2010
10 December 2004 - International Human Rights Day
World No-Tobacco Day
World Health Day
speaker Mr NgThian Watt the Principal Trainer from
Napoleon Hill Associates MalaysiaDetails